There's no doubt that the weight loss industry in America is an inconceivably massive moneymaker for corporations and pharmaceutical companies. It's indisputable. A lot of rich people make a lot of money off the public perception that fat is wrong and that eliminating fat is a national moral mandate of apocalyptic proportions. Panic = dollars. Perhaps less obvious, but no less truthful, is the fact that the diet industry is fueled by a systematic campaign of shame, stigma, and moral superiority that trickles down from the government's "war on obesity" straight into the brains of your friendly neighborhood concern trolls (where it evaporates back up again, and on and on). And yet, clearly, the tireless efforts of the Shame Industrial Complex have not resulted in widespread nationwide weight loss or improved health. So what can we draw from that? Is there more to the story?

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One anonymous doctor ("one of the nation's most distinguished medical researchers, employed by the federal government") thinks so. Via Salon:

Dr. X has a theory about the government's anti-fat crusade, which is that the public health establishment has been duped by Big Pharma into becoming unknowing participants in the following money-making venture:

Step 1: Convince Americans that not being thin is a disease that needs to be cured.

Step 2: Encourage the government to implement public health programs that, through lifestyle interventions, will purportedly make people thinner, and, by hypothesis, healthier.

Step 3: Document the complete failure of these programs in the medical literature.

Step 4: Get the government to approve a host of new diet drugs, since it's now been demonstrated that lifestyle interventions don't do anything to help reverse this deadly epidemic.

Step 5: Profit!

Now, look. I'm not here to jump on any conspiracy theory bandwagons, although there's very little that I'd put past big pharma conglomerates, and weight loss drugs clearly inflame and then exploit people's insecurities for money (while playing fast and loose with their overall health). It wouldn't surprise me one whit if this theory were at least partially true. But, of course, it's just one dude's theory.

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That said, that mystery doctor's inside perspective is a valuable reminder that our nation's battle with weight and health is much more complicated than the general public likes to think. That's it. It's just complicated. And refusing to address those complications, clinging to the simple "eat less/exercise more" model, is an obstructionist attitude that solves nothing. You often hear anti-fat crusaders complaining that "fat people don't want to have an honest conversation about fat," while refusing to acknowledge things like multi-billion-dollar industries that market candy cereal to children and then diet pills to adults. Or the ways that a lifetime of consuming hyperrich foods (deliberately saturated with high fructose corn syrup thanks to federal subsidies) can literally change people's body chemistries and leave them largely powerless to maintain significant longterm weight loss. Or the hold that emotional eating can have over people's lives (I read a story recently about a victim of a brutal childhood rape who says she literally can't feel anything except for the enjoyment of food—you want to tell that woman to "put down the corndog, fatty"?). Or the fact that some people, regardless of lifestyle, are just fat.

To willfully ignore all of those complicating factors means that you DON'T want to have an "honest conversation about fat"—you want to have a masturbatory conversation about your preconceived notions about fat people's self-control.

The Salon piece profiles one study that examined longterm weight loss and health:

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Look AHEAD, which involved more than 5,000 people with diabetes, half of whom participated in an intensive, closely monitored program that limited them to 1,200-1,800 calories per day (depending on the weight of the participant) while they exercised for at least 170 minutes per week, was an attempt to test whether significant long-term weight loss would actually produce reduced risk in terms of what researchers call "hard clinical endpoints" – namely cardiovascular disease and stroke.

The results were unambiguous. Note that, perhaps out of necessity, the study defined "significant long-term weight loss" quite modestly, since on average this intensive lifestyle intervention produced a little less than a 5 percent reduction in body mass (i.e., a 160-pound "overweight" woman in the program weighed, on average, 152 pounds after four years of participation). In other words, what the study proved yet again is that lifestyle interventions don't produce much, if anything, in the way of long-term weight loss.

The study was terminated, however, not for this reason – after all, it defined a 5 percent weight loss as "success" – but because after 11 years the group that had made the lifestyle changes did not exhibit any lower risk for cardiovascular disease or stroke than the control group.

I am not inclined to take that study at face value and say, "See? It IS impossible to lose weight! And all fat people ARE 100% healthy!" (For what it's worth, I don't know of any size acceptance activists who are making outlandish claims like that.) The reality, of course, is fucking complicated. So, honest conversation. Let's do it.

2. But we also do know that people can lose weight, because we see it. I know lots of people who have lost weight. It happens. Personally, my weight has been very slowly dropping over the past year because, I don't know, I'm just really happy lately. I ride my bike and I eat lentils a lot. But I also eat cookies sometimes! Conundrum!!! HOW CAN WEIGHT LOSS AND COOKIES COEXIST!? THE MIND REELS. Or, you know, shit is complicated.

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3. We know that sometimes people lose weight and they see a big health benefit. But we also know that sometimes people lose weight and their health doesn't change one bit. Both of these things are true. Because poor health and large size are not synonymous. Again, complicated.

4. We know that big pharma, big agra, big Weight Watchers, big Susan Powter, big celery, big cabbage soup, and big Little Debbie (for big shame-binging) stand to make tons of cash off of convincing as many Americans as possible to hate ourselves. We do our jobs, obediently, ridiculing fat people for the greater good—even when those fat people are ourselves. That cycle does nothing but help big jerks make big money.

So am I ready to jump on the conspiracy theory bandwagon and declare all weight loss studies to be manipulative malarkey perpetuated by our federal government? Nah. But I DO think that if we're really committed to improving the health of Americans (and children in particular) we need to stop taking the "obesity epidemic" narrative at face value. Let's have an honest conversation, sure. But let's be honest about what "honest" means.